Provider Demographics
NPI:1013608108
Name:GLAVARIS, MEREDETH
Entity Type:Individual
Prefix:
First Name:MEREDETH
Middle Name:
Last Name:GLAVARIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1307
Mailing Address - Country:US
Mailing Address - Phone:614-965-5314
Mailing Address - Fax:
Practice Address - Street 1:2721 4TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1307
Practice Address - Country:US
Practice Address - Phone:614-965-5314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker